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HomeMy WebLinkAboutCLE201800028 Application 2018-02-09t/ Application for Zoning Clearance CLE # '�AG1t�1P OFFICE U 61, Y c Check #Date: PLEASE REVIE`V ALL 3 SHEETS Receipt # Staff: PARCEL INFORMATION �C Map OG 000 — 00-00 �/C. Tax and Parcels ( Existing Zoning Parcel Owner: . t(.��t; !��\ �dL E�51 L �. C �l0 rS n � In L —���/q Parcel Address: Z Z ( Y City (�gIIQ W j r'� L State U Zip L21O3 (includk suite or floor) PRIMARY CONTACT Who W ©Z, should we call/write concerning this project? s 4-I Address: -ZLk \ City G V"-fsy" 1lR State Zip Z20 r 3 Office Phone: h3h) Z q Cell # q34 Z4Sl([ 8 Fax # E-mail APPLICANT INFORMATION Check any that apply: Change of ownership Change of use Change of name New business Business Name/Type: ;y`�J, 10\ I'\C , bsk z4 -v 14 & " Previous Business on this site M t\�� c� w S Describe the proposed business including use, number of employees, number o shifts, available parking spaces, number of vehicles, and any additional information that you can provide: �(�� Ccx,nr Gat 100j *This Clearance will only be valid on the parcel for which it is approved- if you change; intensify or move the use to a rew location; a new Zoning Clearance will be required. I hereby certify that I own or ve m e owner's pennission to use the space indicated on this application. I also certify that the information provided is true and accurate t my knowledge. 1 have read the conditions of approval, and I understand them; and that I will abide by them. Signature Printed ©. Y M Etf AP ROYAL IN RT\IATION [ Approved as proposed [ ] Approved with conditions [ ] Denied [ ckflow prevention device and/or cunent test data needed for this site. Contact ACSA, 977-451 1, x l 17. [ VfNo physical site inspection has been done for this clearance. Therefore; it is not a determination of compliance with the existing site plan. [ ] This site complies with the site plan as of this date. Notes: Building Official Date lc� l Zoning Official Date -L111Zo]? Other Official VDN - Ste OAAA(%c� pe t'Ynt-E- Date 1�kast C1'k1 Count}of Albemarle Department of Community Development 461 Mcintire Road Charlottesville, VA 22902 Voice: (434) 2.96-5,832 Fax: (434) 972-4126 Rt-vi ed 11 02 2W s Pave 2 of 3 .�o�1C,,, lo�►� S afi ���{��t � � I'l a I Intake to complete the following: Y / t, •l Is use in L1, III or PD1P zoning? If so, give applicant a Certified Engineer's Report (CER) packet. Nt Will there be food preparation? If so, give applicant a Health Department form. Zoning review can not begin until ive receive approval r om Health Dept. FAX DATE Circle the one that applies Is parcel on private well o�ejpammnwnl ? If private well, provide Neform. Zoning review can not begin until we receive approval fi-on) Health Dept. FAX DATE Circle the one that applies Is parcel on septic Zjpublic se er. Y/N Will you be putting up a new sign of any kind? Ifso, obtain proper Sign pennit. Permit # WNW IPVAle el) sePe{CAr-e �cfy'►It Will there be any new construclion or renovations? If so, obtain the proper Permit. Permit # WWId fet o4t R feptlate p.orm zonin! t Revieiver to complete the folio wing: Square footage of Use: !� Z(d0 N Permitted as: QO1bitjt�rn�yi� Under Section: 2 4,2- \ (3 0 Supplementary regulations section: Parking formula: taSfaum'11 13 /IOoo 4t L ci o Required spaces: Y/N lie , be verified in the field: Inspector : Date: Notes: cbang oT owy)e[4� 6n Rerked 11 r 1 201 5 pare 3 <,f 3 ('0111to\'W 11.I'll Of' VIRGI 11 I tlRGJAI I F)EIIAR111f_.ti?'vf-i11:.ILlll fR t7CC�+r��'+if� y{'. :.. - _ � � .'��` :,•:; -i 4,,7�sr ��� �h't� Livida Incorporated :S by "Od e pe!mVic"Se t-f the ftem,arle Comfy Health Department . ;cn_ s. Fall Berme Hwaurzy-f r�rt {ice ZAZUS FRESH & HEALTHY �2141vy Road Unit 0111 CharloKesvift VA. 22903 2214 Ivy Road Unft i 111, Charlottes villa, VA, 22903 Da!e ! !r-'i1'-al.Kiin January 31, 2019 --~ J Caaarrdra Styles Environmental Health Specialist; Sr, THIS PERMfTj i5 NOT TRANSFERABLE FROM ONE INDW1DUAL OR LOCATION TO ANOTHER Now owners are required to make written application for a pornnit %0" 0'er�t Qwvons o{ wCcwx *ns `0 Atom County Health Department Fnwronmental Health Services 1138 Rose Hill Drive Chartottes}w�a it VA 22903 N. f8 �47 lz r 1 i